Erland Hermansen1,2,3, Ivar Magne Austevoll4,5, Christian Hellum6, Kjersti Storheim7, Tor Åge Myklebust8, Jørn Aaen9,10, Hasan Banitalebi11,12, Masoud Anvar13, Frode Rekeland4, Jens Ivar Brox14, Eric Franssen15, Clemens Weber16,17, Tore Solberg18,19, Knut Jørgen Haug20, Oliver Grundnes21, Helena Brisby22,23, Kari Indrekvam4,5. 1. Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway. Erland.hermansen@helse-bergen.no. 2. Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway. Erland.hermansen@helse-bergen.no. 3. Department of Clinical Medicine, University of Bergen, Bergen, Norway. Erland.hermansen@helse-bergen.no. 4. Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway. 5. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 6. Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway. 7. Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo University Hospital,, Oslo, Norway. 8. Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway. 9. Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway. 10. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway. 11. Department of Diagnostic Imaging, Akershus University Hospital,, Oslo, Norway. 12. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 13. Unilabs Radiology, Oslo, Norway. 14. Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. 15. Department of Orthopaedics, Stavanger University Hospital, Stavanger, Norway. 16. Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway. 17. Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway. 18. Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsö, Norway. 19. Institute of Clinical Medicine, The Arctic University of Norway, Tromsö, Norway. 20. Departement of Orthopedic Surgery, Telemark Regional Hospital, Skien, Norway. 21. Department of Orthopedics, Akershus University Hospital, Oslo, Norway. 22. Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden. 23. Department of Orthopaedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Abstract
PURPOSE: To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. METHODS: The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. RESULTS: No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. CONCLUSION: For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. CLINICAL TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.
RCT Entities:
PURPOSE: To investigate changes in dural sac area after three different posterior decompression techniques in patients undergoing surgery for lumbar spinal stenosis. Decompression of the nerve roots is the main surgical treatment for lumbar spinal stenosis. The aim of this study was to radiologically investigate three commonly used posterior decompression techniques. METHODS: The present study reports data from one of two multicenter randomized trials included in the NORDSTEN study. In the present trial, involving 437 patients undergoing surgery, we report radiological results after three different midline retaining posterior decompression techniques: unilateral laminotomy with crossover (UL) (n = 146), bilateral laminotomy (BL) (n = 142) and spinous process osteotomy (SPO) (n = 149). MRI was performed before and three months after surgery. The increase in dural sac area and Schizas grade at the most stenotic level was evaluated. Three different predefined surgical indicators of substantial decompression were used: (1) postoperative dural sac area of > 100 mm2, (2) increase in the dural sac area of at least 50% and (3) postoperative Schizas grade A or B. RESULTS: No differences between the three surgical groups were found in the mean increase in dural sac area. Mean values were 66.0 (SD 41.5) mm2 in the UL-group, 71.9 (SD 37.1) mm2 in the BL-group and 68.1 (SD 41.0) mm2 in the SPO-group (p = 0.49). No differences in the three predefined surgical outcomes between the three groups were found. CONCLUSION: For patients with lumbar spinal stenosis, the three different surgical techniques provided the same increase in dural sac area. CLINICAL TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov reference on November 22th 2013 under the identifier NCT02007083.
Authors: Erland Hermansen; Ivar Magne Austevoll; Christian Hellum; Kjersti Storheim; Tor Åge Myklebust; Jørn Aaen; Hasan Banitalebi; Masoud Anvar; Frode Rekeland; Jens Ivar Brox; Eric Franssen; Clemens Weber; Tore K Solberg; Håvard Furunes; Oliver Grundnes; Helena Brisby; Kari Indrekvam Journal: JAMA Netw Open Date: 2022-03-01